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Duroux D, Wohlfart C, Van Steen K, Vladimirova A, King M. Graph-based multi-modality integration for prediction of cancer subtype and severity. Sci Rep 2023; 13:19653. [PMID: 37949935 PMCID: PMC10638406 DOI: 10.1038/s41598-023-46392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
Personalised cancer screening before therapy paves the way toward improving diagnostic accuracy and treatment outcomes. Most approaches are limited to a single data type and do not consider interactions between features, leaving aside the complementary insights that multimodality and systems biology can provide. In this project, we demonstrate the use of graph theory for data integration via individual networks where nodes and edges are individual-specific. We showcase the consequences of early, intermediate, and late graph-based fusion of RNA-Seq data and histopathology whole-slide images for predicting cancer subtypes and severity. The methodology developed is as follows: (1) we create individual networks; (2) we compute the similarity between individuals from these graphs; (3) we train our model on the similarity matrices; (4) we evaluate the performance using the macro F1 score. Pros and cons of elements of the pipeline are evaluated on publicly available real-life datasets. We find that graph-based methods can increase performance over methods that do not study interactions. Additionally, merging multiple data sources often improves classification compared to models based on single data, especially through intermediate fusion. The proposed workflow can easily be adapted to other disease contexts to accelerate and enhance personalized healthcare.
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Affiliation(s)
- Diane Duroux
- BIO3 - Systems Genetics, GIGA-R Medical Genomics, University of Liège, 4000, Liège, Belgium.
- Post-Doctoral Fellow, ETH AI center, Zürich, Switzerland.
| | | | - Kristel Van Steen
- BIO3 - Systems Genetics, GIGA-R Medical Genomics, University of Liège, 4000, Liège, Belgium
- Department of Human Genetics, BIO3 - Systems Medicine, 3000, Leuven, Belgium
| | - Antoaneta Vladimirova
- Roche Information Solutions, Roche Diagnostics Corporation, Santa Clara, California, United States of America
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2
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Olczak M, Orzechowska MJ, Bednarek AK, Lipiński M. The Transcriptomic Profiles of ESR1 and MMP3 Stratify the Risk of Biochemical Recurrence in Primary Prostate Cancer beyond Clinical Features. Int J Mol Sci 2023; 24:ijms24098399. [PMID: 37176106 PMCID: PMC10179071 DOI: 10.3390/ijms24098399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
The molecular determinants of the heterogenic course of prostate cancer (PC) remain elusive. We aimed to determine the drivers predisposing to unfavorable PC outcomes anticipated by BCR events among patients of similar preoperative characteristics. The TCGA transcriptomic and clinical data of 497 PC individuals were used, stratified according to the risk of BCR by EAU-EANM-ESTRO-ESUR-SIOG. The relevance of the functional markers regarding BCR-free survival was examined by the cutp algorithm. Through UpSetR, subgroups of PC patients bearing an unfavorable signature were identified, followed by the hierarchical clustering of the major markers of the epithelial-to-mesenchymal transition (EMT). BCR-free survival was estimated with the Cox proportional hazards regression model. ESR1 significantly differentiated BCR-free survival, whereas AR did not. An elevation in KLK3 correlated with better prognosis, although PGR, KLK3, CDH1, and MMP3 predicted BCR better than the preoperative PSA level. Patients sharing an unfavorable profile of ESR1 and MMP3 together with lymph node status, Gleason score, T, and EAU risk groups were at a higher risk of BCR originating from mesenchymal features of PC cells. To conclude, we revealed an ESR1-driven unfavorable profile of EMT underpinning a worse PC trajectory. ESR1 may have a major role in PC progression; therefore, it could become a major focus for further investigations.
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Affiliation(s)
- Michał Olczak
- II Clinic of Urology, Medical University of Lodz, Pabianicka 62, 93-513 Lodz, Poland
| | | | - Andrzej K Bednarek
- Department of Molecular Carcinogenesis, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
| | - Marek Lipiński
- II Clinic of Urology, Medical University of Lodz, Pabianicka 62, 93-513 Lodz, Poland
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3
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Kumar GV, Bellary MI, Reddy TB. Prostate cancer classification with MRI using Taylor-Bird Squirrel Optimization based Deep Recurrent Neural Network. THE IMAGING SCIENCE JOURNAL 2023. [DOI: 10.1080/13682199.2023.2165242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Goddumarri Vijay Kumar
- Dept. of Computer Science and Technology, Sri Krishnadevaraya University, Ananthapuram, A.P., India
| | - Mohammed Ismail Bellary
- Department of Artificial Intelligence & Machine Learning, P.A. College of Engineering, Managalore, Affiliated to Visvesvaraya Technological University, Belagavi, K.A., India
| | - Thota Bhaskara Reddy
- Dept. of Computer Science and Technology, Sri Krishnadevaraya University, Ananthapuram, A.P., India
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Andolfi C, Vickers AJ, Cooperberg MR, Carroll PR, Cowan JE, Paner GP, Helfand BT, Liauw SL, Eggener SE. Blood Prostate-specific Antigen by Volume of Benign, Gleason Pattern 3 and 4 Prostate Tissue. Urology 2022; 170:154-160. [PMID: 35987380 PMCID: PMC10515713 DOI: 10.1016/j.urology.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate how blood levels of prostate-specific antigen (PSA) relate to prostate volume of benign tissue, Gleason pattern 3 (GP3) and Gleason pattern 4 (GP4) cancer. METHODS The cohort included 2209 consecutive men undergoing radical prostatectomy at 2 academic institutions with pT2N0, Grade Group 1-4 prostate cancer and an undetectable postoperative PSA. Volume of benign, GP3, and GP4 were estimated. The primary analysis evaluated the association between PSA and volume of each type of tissue using multivariable linear regression. R2, a measure of explained variation, was calculated using a multivariable model. RESULTS Estimated contribution to PSA was 0.04/0.06 ng/mL/cc for benign, 0.08/0.14 ng/mL/cc for GP3, and 0.62/0.80 ng/ml/cc for GP4 for the 2 independent cohorts, respectively. GP4 was associated with 6 to 8-fold more PSA per cc compared to GP3 and 15-fold higher compared to benign tissue. We did not observe a difference between PSA per cc for GP3 vs. benign tissue (P = 0.2). R2 decreased only slightly when removing age (0.006/0.018), volume of benign tissue (0.051/0.054) or GP3 (0.014/0.023) from the model. When GP4 was removed, R2 decreased 0.051/0.310. PSA density (PSA divided by prostate volume) was associated with volume of GP4 but not GP3, after adjustment for benign volume. CONCLUSION Gleason pattern 4 cancer contributes considerably more to PSA and PSA density per unit volume compared to GP3 and benign tissue. Contributions from GP3 and benign are similar. Further research should examine the utility of determining clinical management recommendations by absolute volume of GP4 rather than the ratio of GP3 to GP4.
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Affiliation(s)
- Ciro Andolfi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
| | - Andrew J Vickers
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Janet E Cowan
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gladell P Paner
- Department of Pathology, The University of Chicago, Chicago, IL
| | | | - Stanley L Liauw
- Department of Radiation Oncology, The University of Chicago, Chicago, IL
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Wang C, Liu G, Liu Y, Yang Z, Xin W, Wang M, Li Y, Yang L, Mu H, Zhou C. Novel serum proteomic biomarkers for early diagnosis and aggressive grade identification of prostate cancer. Front Oncol 2022; 12:1004015. [PMID: 36276156 PMCID: PMC9582260 DOI: 10.3389/fonc.2022.1004015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is one of the most common tumors and the second leading cause of cancer-related death in men. The discovery of novel biomarkers for PCa diagnosis in the early stage, as well as discriminating aggressive PCa from non-aggressive PCa continue to pose a challenge. The aim of this study was to identify serum proteins that were sensitive and specific enough to detect early-stage and aggressive PCa. METHODS The serum proteomic profiling of patients with PCa and benign prostatic hyperplasia (BPH) was comprehensively analyzed using data-independent acquisition mass spectrometry (DIA-MS), and the bioinformatics analysis was performed. The differentially expressed proteins (DEPs) of interest were further verified by enzyme-linked immunosorbent assay (ELISA) and immunoturbidimetry assay. RESULTS Statistically significant difference in abundance showed 56 DEPs between early-stage PCa and BPH and 47 DEPs between aggressive and non-aggressive PCa patients. In addition, the verification results showed that serum L-selectin concentration was significantly higher (p<0.05) in Gleason 6 PCa when compared with BPH, and the concentration of osteopontin (SPP1) and ceruloplasmin (CP) increased with higher Gleason score. CONCLUSIONS DIA-MS has great potential in cancer-related biomarker screening. Our data demonstrated that adding SPP1 and CP to PSA improved the separation of Gleason 7 (4 + 3) or above from Gleason 7 (3 + 4) or below compared with PSA diagnosis alone. Serum SPP1 and CP could be effective biomarkers to differentiate aggressive PCa (especially Gleason 7 (4 + 3) or above) from non-aggressive disease.
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Affiliation(s)
- Ce Wang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Guangming Liu
- Department of Urology Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yehua Liu
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Zhanpo Yang
- Department of Urology Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Weiwei Xin
- Department of Pathology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Meng Wang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yang Li
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Lan Yang
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Hong Mu
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Chunlei Zhou
- Department of Clinical Laboratory, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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Zhang W, Zhang K. A transcriptomic signature for prostate cancer relapse prediction identified from the differentially expressed genes between TP53 mutant and wild-type tumors. Sci Rep 2022; 12:10561. [PMID: 35732666 PMCID: PMC9217948 DOI: 10.1038/s41598-022-14436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/07/2022] [Indexed: 11/12/2022] Open
Abstract
For prostate cancer (PCa) patients, biochemical recurrence (BCR) is the first sign of disease relapse and the subsequent metastasis. TP53 mutations are relatively prevalent in advanced PCa forms. We aimed to utilize this knowledge to identify robust transcriptomic signatures for BCR prediction in patients with Gleason score ≥ 7 cancers, which cause most PCa deaths. Using the TCGA-PRAD dataset and the novel data-driven stochastic approach proposed in this study, we identified a 25-gene signature from the genes whose expression in tumors was associated with TP53 mutation statuses. The predictive strength of the signature was assessed by AUC and Fisher’s exact test p-value according to the output of support vector machine-based cross validation. For the TCGA-PRAD dataset, the AUC and p-value were 0.837 and 5 × 10–13, respectively. For five external datasets, the AUCs and p-values ranged from 0.632 to 0.794 and 6 × 10–2 to 5 × 10–5, respectively. The signature also performed well in predicting relapse-free survival (RFS). The signature-based transcriptomic risk scores (TRS) explained 28.2% of variation in RFS on average. The combination of TRS and clinicopathologic prognostic factors explained 23–72% of variation in RFS, with a median of 54.5%. Our method and findings are useful for developing new prognostic tools in PCa and other cancers.
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Affiliation(s)
- Wensheng Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research, Xavier University of Louisiana, New Orleans, LA, 70125, USA.
| | - Kun Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research, Xavier University of Louisiana, New Orleans, LA, 70125, USA. .,Department of Computer Science, Xavier University of Louisiana, New Orleans, LA, 70125, USA.
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Zhang W, Dong Y, Sartor O, Zhang K. Deciphering the Increased Prevalence of TP53 Mutations in Metastatic Prostate Cancer. Cancer Inform 2022; 21:11769351221087046. [PMID: 35392296 PMCID: PMC8980432 DOI: 10.1177/11769351221087046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 12/30/2022] Open
Abstract
The prevalence of TP53 mutations in advanced prostate cancers (PCa) is 3 to 5 times of the quantity in primary PCa. By an integrative analysis of the Cancer Genome Atlas and Catalogue of Somatic Mutations in Cancer data, we revealed the supporting evidence for 2 complementary hypotheses: H1 - TP53 abnormalities promote metastasis or therapy-resistance of PCa cells, and H2—part of TP53 mutations in PCa metastases occur after the diagnosis of original cancers. The plausibility of these hypotheses can explain the increased prevalence of TP53 mutations in PCa metastases. With H1 and H2 as the general assumptions, we developed mathematical models to decipher the change of the percentage frequency (prevalence) of TP53 mutations from primary tumors to metastases. The following results were obtained. Compared to TP53-normal patients, TP53-mutated patients had poorer biochemical relapse-free survival, higher Gleason scores, and more advanced t-stages (P < .01). Single-nucleotide variants in metastases more frequently occurred on G bases of the coding sequence than those in primary cancers (P = .03). The profile of TP53 hotspot mutations was significantly different between primary and metastatic PCa as demonstrated in a set of statistical tests (P < .05). By the derived formulae, we estimated that about 40% TP53 mutation records collected from metastases occurred after the diagnosis of the original cancers. Our study provided significant insight into PCa progression. The proposed models can also be applied to decipher the prevalence of mutations on TP53 (or other driver genes) in other cancer types.
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Affiliation(s)
- Wensheng Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research, Xavier University of Louisiana, New Orleans, LA, USA
| | - Yan Dong
- Department of Structural and Cellular Biology, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, LA, USA
| | - Oliver Sartor
- Department of Medicine, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, LA, USA
| | - Kun Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research, Xavier University of Louisiana, New Orleans, LA, USA
- Department of Computer Science, Xavier University of Louisiana, New Orleans, LA, USA
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Jain B, Ng K, Santos PMG, Taparra K, Muralidhar V, Mahal BA, Vapiwala N, Trinh QD, Nguyen PL, Dee EC. Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups. JCO Oncol Pract 2022; 18:e204-e218. [PMID: 34709962 PMCID: PMC8758129 DOI: 10.1200/op.21.00412] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/16/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors. METHODS We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors. RESULTS Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients. CONCLUSION Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Kenrick Ng
- Department of Medical Oncology, Barts Health NHS Trust, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | | | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Brandon A. Mahal
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Harvard Medical School, Boston, MA
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Aslim EJ, Law YXT, Fook-Chong SMC, Ho HSS, Yuen JSP, Lau WKO, Lee LS, Cheng CWS, Ngo NT, Law YM, Tay KJ. Defining prostate cancer size and treatment margin for focal therapy: does intralesional heterogeneity impact the performance of multiparametric MRI? BJU Int 2021; 128:178-186. [PMID: 33539650 PMCID: PMC8360156 DOI: 10.1111/bju.15355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. PATIENTS AND METHODS We identified men who underwent primary radical prostatectomy for organ- confined prostate cancer over a 3-year period. Cancer foci on whole-mount histology were marked out, coding low-grade (LG; Gleason 3) and high-grade (HG; Gleason 4-5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, <50% and ≥50%; the readings were corrected for specimen shrinkage and correlated with matching lesions on mpMRI. Separate measurements were also taken of HG cancer components only, and correlated against entire lesions on mpMRI. Size discrepancies were used to derive the optimal tumour size and treatment margins for FT. RESULTS There were 122 MRI-detected cancer lesions in 70 men. The mean linear specimen shrinkage was 8.4%. The overall correlation between histology and MRI dimensions was r = 0.79 (P < 0.001). Size correlation was superior for tumours with high burden (≥50%) compared to low burden (<50%) of HG cancer (r = 0.84 vs r = 0.63; P = 0.007). Size underestimation by mpMRI was more likely for larger tumours (51% for >12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5-6 mm for FT. For tumours ≤12 mm in diameter, applying 5- and 6-mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components. CONCLUSIONS Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.
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Affiliation(s)
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, Singapore City, Singapore
| | | | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - John Shyi Peng Yuen
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Weber Kam On Lau
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore City, Singapore
| | | | - Nye Thane Ngo
- Department of Anatomical Pathology, Singapore General Hospital, Singapore City, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore City, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
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Song ZJ, Qian JK, Yang Y, Wu HX, Wang MY, Jiang SY, Wang FB, Zhang W, Chen R. PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium. Asian J Androl 2021; 23:300-305. [PMID: 33208562 PMCID: PMC8152427 DOI: 10.4103/aja.aja_61_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We performed this study to investigate the diagnostic performance of prostate-specific antigen density (PSAD) in a multicenter cohort of the Chinese Prostate Cancer Consortium. Outpatients with prostate-specific antigen (PSA) levels ≥4.0 ng ml−1 regardless of digital rectal examination (DRE) results or PSA levels <4.0 ng ml−1 and abnormal DRE results were included from 18 large referral hospitals in China. The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer (PCa) and high-grade prostate cancer (HGPCa) at different cutoff values were evaluated. A total of 5220 patients were included in the study, and 2014 (38.6%) of them were diagnosed with PCa. In patients with PSA levels ranging from 4.0 to 10.0 ng ml−1, PSAD was associated with PCa and HGPCa in both univariate (odds ratio [OR] = 45.15, P < 0.0001 and OR = 25.38, P < 0.0001, respectively) and multivariate analyses (OR = 52.55, P < 0.0001 and OR = 26.05, P < 0.0001, respectively). The areas under the receiver operating characteristic curves (AUCs) of PSAD in predicting PCa and HGPCa were 0.627 and 0.630, respectively. With the PSAD cutoff of 0.10 ng ml−2, we obtained a sensitivity of 88.7% for PCa, and nearly all (89.9%) HGPCa cases could be detected and biopsies could be avoided in 20.2% of the patients (359/1776 cases). Among these patients who avoided biopsies, only 30 cases had HGPCa. We recommend 0.10 ng ml−2 as the proper cutoff value of PSAD, which will obtain a sensitivity of nearly 90% for both PCa and HGPCa. The results of this study should be validated in prospective, population-based multicenter studies.
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Affiliation(s)
- Zi-Jian Song
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Jin-Ke Qian
- Department of Urology, Binhai People's Hospital, Yancheng 224500, China
| | - Yue Yang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Han-Xiao Wu
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Mao-Yu Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Si-Yuan Jiang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Fu-Bo Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Wei Zhang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
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11
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Zhou Y, Lin C, Hu Z, Yang C, Zhang R, Ding Y, Wang Z, Tao S, Qin Y. Differences in survival of prostate cancer Gleason 8-10 disease and the establishment of a new Gleason survival grading system. Cancer Med 2020; 10:87-97. [PMID: 33135335 PMCID: PMC7826472 DOI: 10.1002/cam4.3571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Although the latest Gleason grading system in 2014 has distinguished between Gleason 3 + 4 and 4 + 3, Gleason 8 and Gleason 9–10 are remained systemically classified. Methods A total of 261,125 patients diagnosed with prostate cancer (PCa) were selected between 2005 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity score matching to balance clinical variables and then compared overall survival (OS) and cancer‐specific survival (CSS) between Gleason score subgroups. We further establish a new Gleason survival grading system based on the hazard ratio (HR) values of each Gleason subgroup. Cox proportional hazards models and Kaplan–Meier curves were used to compare patient survival. Results Among PCa patients with Gleason score 8 disease, patients with Gleason 5 + 3 had significantly worse OS and CSS than those with Gleason 3 + 5 (OS: HR = 1.26, p = 0.042; CSS: HR = 1.42, p = 0.005) and 4 + 4 (HR = 1.50 for OS and HR = 1.69 for CSS, p < 0.001 for all). PCa patients with Gleason 5 + 3 and Gleason 4 + 5 may have the similar OS and CSS (reference Gleason score <=6, 5 + 3: OS HR = 2.44, CSS HR = 7.63; 4 + 5: OS HR = 2.40, CSS HR = 8.92; p < 0.001 for all). The new Gleason survival grading system reclassified the grades 4 and 5 of the 2014 updated Gleason grading system into three hierarchical grades, which makes the classification of grades more detailed and accurate. Conclusion PCa patients with Gleason 8–10 may have three different survival subgroups, Gleason 3 + 5 and 4 + 4, Gleason 5 + 3 and 4 + 5, and Gleason 5 + 4 and 5 + 5. Our results maximize risk stratification for PCa patients, provide guidance for clinicians to assess their survival and clinical management, and make a recommendation for the next Gleason grading system update.
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Affiliation(s)
- Yuan Zhou
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Changming Lin
- Department of Urology Surgery, The Fourth Affiliated Hospital of AnHui Medical University, Hefei, China
| | - Zhihua Hu
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Cheng Yang
- Department of Urology Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rentao Zhang
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Yinman Ding
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Zhengquan Wang
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Sha Tao
- Department of Urology Surgery, The People's Hospital of Xuancheng City, Xuancheng, China.,Wannan Medical College, Yijiang, China
| | - Yanmei Qin
- Shanghai Key Laboratory of Tuberculosis, Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Zhang W, Dong Y, Zhang K. Gene expression analysis reveals a pitfall in the molecular research of prostate tumors relevant to Gleason score. J Bioinform Comput Biol 2020; 18:2050032. [PMID: 32938283 DOI: 10.1142/s0219720020500328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gleason score (GS) is a powerful prognostic factor in prostate cancer (PCa). A GS-7 tumor typically has the primary Gleason (architectural) pattern and secondary prevalent one being graded with 3 and 4 (or 4 and 3), respectively. Due to the well-known intratumoral multifocal occurrence of different patterns, a biological sample from a GS-7 tumor used in a molecular experiment will be uncertain regarding the actually represented pattern if no special attention is given to specimen preparation. In this study, by an integrative analysis of several published gene expression datasets, one of which is the profiling of the paired GP-3 (Gleason pattern 3) and GP-4 (Gleason pattern 4) specimens of 13 GS-7 tumors, we demonstrate that such an uncertainty can be frequently observed in the published data. More specifically, our results suggest that the GS-7 specimens used to generate the frequently-cited The Cancer Genome Atlas (TCGA) data and the Gene Expression Omnibus (GEO) dataset GSE21032 which largely are individual GP-3 or GP-4 specimens rather than the "intermediate" specimens of GP-3 and GP-4. This indicates a pitfall in the existing molecular research of prostate tumors relevant to GS and in GS-related molecular biomarker identification using the previously documented data.
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Affiliation(s)
- Wensheng Zhang
- Bioinformatics core of Xavier NIH RCMI Cancer Research Center, Xavier University of Louisiana, New Orleans, LA 70125, USA
| | - Yan Dong
- Department of Structural and Cellular Biology, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, LA 70112, USA
| | - Kun Zhang
- Bioinformatics core of Xavier NIH RCMI Cancer Research Center, Xavier University of Louisiana, New Orleans, LA 70125, USA
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13
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Zhang W, Dong Y, Sartor O, Flemington EK, Zhang K. SEER and Gene Expression Data Analysis Deciphers Racial Disparity Patterns in Prostate Cancer Mortality and the Public Health Implication. Sci Rep 2020; 10:6820. [PMID: 32321981 PMCID: PMC7176737 DOI: 10.1038/s41598-020-63764-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/30/2020] [Indexed: 01/13/2023] Open
Abstract
A major racial disparity in prostate cancer (PCa) is that African American (AA) patients have a higher mortality rate than European American (EA) patients. We filtered the SEER 2009-2011 records and divided them into four groups regarding patient races and cancer grades. On such a partition, we performed a series of statistical analyses to further clarify the aforementioned disparity. Molecular evidence for a primary result of the epidemiological analysis was obtained from gene expression data. The results include: (1) Based on the registry-specific measures, a significant linear regression of total mortality rate (as well as PCa specific mortality rate) on the percentage of (Gleason pattern-based) high-grade cancers (PHG) is demonstrated in EAs (p < 0.01) but not in AAs; (2) PHG and its racial disparity are differentiated across ages and the groups defined by patient outcomes; (3) For patients with cancers in the same grade category, i.e. the high or low grade, the survival stratification between races is not significant in most geographical areas; and (4) The genes differentially expressed between AAs' and EAs' tumors of the same grade category are relatively rare. The perception that prostate tumors are more lethal in AAs than in EAs is reasonable regarding AAs' higher PHG, while high grade alone could not imply aggressiveness. However, this perception is questionable when the comparison is focused on cases within the same grade category. Supporting observations for this conclusion hold a remarkable implication for erasing racial disparity in PCa. That is, "Equal grade, equal outcomes" is not only a verifiable hypothesis but also an achievable public health goal.
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Affiliation(s)
- Wensheng Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research; Department of Computer Science, Xavier University of Louisiana, New Orleans, 70125, LA, USA
| | - Yan Dong
- Department of Structural and Cellular Biology, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, 70112, LA, USA
| | - Oliver Sartor
- Department of Medicine, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, 70112, LA, USA
| | - Erik K Flemington
- Department of Pathology, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, 70112, LA, USA
| | - Kun Zhang
- Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research; Department of Computer Science, Xavier University of Louisiana, New Orleans, 70125, LA, USA.
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14
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Zuo Y, Liang Y, Zhang J, Hao Y, Li M, Wen Z, Zhao Y. Transcriptome Analysis Identifies Piwi-Interacting RNAs as Prognostic Markers for Recurrence of Prostate Cancer. Front Genet 2019; 10:1018. [PMID: 31695724 PMCID: PMC6817565 DOI: 10.3389/fgene.2019.01018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
Prostate cancer remains the second leading cause of male cancer death, and there is an unmet need for biomarkers to identify patients with such aggressive disease. Piwi-inteacting RNAs (piRNAs) have been classified as transcriptional and posttranscriptional regulators in somatic cells. In this study, we discovered three piRNAs as novel prognostic markers and their association with prostate cancer biochemical recurrence was confirmed in validation data set. To obtain a better understanding of piRNA expression patterns in prostate cancer and to find gene coexpression with piRNAs, we performed weighted gene coexpression network analysis. Target genes of three piRNAs have also been predicted based on base complementarity and expression correlativity. Functional analysis revealed the relationships between target genes and prostate cancer. Our work also identified differential expression of piRNAs between Gleason stage 3 + 4 and 4 + 3 prostate cancer. Overall, this study may explain the roles and demonstrate the potential clinical utility of piRNAs in prostate cancer in a way.
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Affiliation(s)
- Yuanli Zuo
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yu Liang
- College of Chemistry, Sichuan University, Chengdu, China
| | - Jiting Zhang
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yingyi Hao
- College of Chemistry, Sichuan University, Chengdu, China
| | - Menglong Li
- College of Chemistry, Sichuan University, Chengdu, China
| | - Zhining Wen
- College of Chemistry, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Yun Zhao
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
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15
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Perrot E, Seddik S, Gourtaud G, Eyraud R, Roux V, Moureaux C, Blanchet P, Brureau L. Biopsy Grade Group as a reliable prognostic factor for BCR in Afro-Caribbean men with intermediate- and high-risk prostate cancer. World J Urol 2019; 38:1493-1499. [PMID: 31485740 DOI: 10.1007/s00345-019-02931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The Grade Group (GG) classification is recommended by guidelines as a reliable prognostic factor of prostate cancer. However, most studies have been performed on the Caucasian population. Our objective was to validate GG classification as a safe way to classify intermediate- and high-risk patients with African ancestry. PATIENTS AND METHODS This was a retrospective study in an Afro-Caribbean population. A total of 1236 patients were included between 2000 and 2015. Patients were stratified according to (GG). Survival analysis was performed using the Kaplan-Meier method, univariate and multivariate analyses using the Cox model. RESULTS There was no significant difference at 5 and 10-year BCR-free survival between the intermediate- and high-risk groups, based on the D'Amico classification. There was a highly significant difference in BCR-free survival at 5 (p < 0.0001) and 10 years (p < 0.0001) for patients of GG 1 and 2 vs 3, 4, and 5, respectively. There was no significant difference in 5-year BCR-free survival of patients of GG grades 1 and 2, whether lymph-node dissection was performed or not. There was a significant difference between GG 2 and 3 patients in 5 (p = 0.008) and 10-year BCR-free survival (p = 0.01). High PSA (p < 0.0001), pathological GG ≥ 3 (p < 0.0001), pathological stage pT3 (p < 0.0001) and positive margins (p < 0.0001) were factors for BCR in multivariate analysis. CONCLUSION The GG 2015 classification appears to be a better prognostic factor than D'Amico classification for intermediate- and high-risk Afro-Caribbean patients.
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Affiliation(s)
- Emmanuel Perrot
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Sofiane Seddik
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Gilles Gourtaud
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Rémi Eyraud
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Virginie Roux
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Clément Moureaux
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France
| | - Pascal Blanchet
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France.,CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-a-Pitre, France
| | - Laurent Brureau
- Service d'Urologie, CHU de Pointe-à-Pitre, 97159, Pointe-a-Pitre, France. .,CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, Pointe-a-Pitre, France.
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16
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Zhong X, Cao R, Shakeri S, Scalzo F, Lee Y, Enzmann DR, Wu HH, Raman SS, Sung K. Deep transfer learning-based prostate cancer classification using 3 Tesla multi-parametric MRI. Abdom Radiol (NY) 2019; 44:2030-2039. [PMID: 30460529 DOI: 10.1007/s00261-018-1824-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to propose a deep transfer learning (DTL)-based model to distinguish indolent from clinically significant prostate cancer (PCa) lesions and to compare the DTL-based model with a deep learning (DL) model without transfer learning and PIRADS v2 score on 3 Tesla multi-parametric MRI (3T mp-MRI) with whole-mount histopathology (WMHP) validation. METHODS With IRB approval, 140 patients with 3T mp-MRI and WMHP comprised the study cohort. The DTL-based model was trained on 169 lesions in 110 arbitrarily selected patients and tested on the remaining 47 lesions in 30 patients. We compared the DTL-based model with the same DL model architecture trained from scratch and the classification based on PIRADS v2 score with a threshold of 4 using accuracy, sensitivity, specificity, and area under curve (AUC). Bootstrapping with 2000 resamples was performed to estimate the 95% confidence interval (CI) for AUC. RESULTS After training on 169 lesions in 110 patients, the AUC of discriminating indolent from clinically significant PCa lesions of the DTL-based model, DL model without transfer learning and PIRADS v2 score ≥ 4 were 0.726 (CI [0.575, 0.876]), 0.687 (CI [0.532, 0.843]), and 0.711 (CI [0.575, 0.847]), respectively, in the testing set. The DTL-based model achieved higher AUC compared to the DL model without transfer learning and PIRADS v2 score ≥ 4 in discriminating clinically significant lesions in the testing set. CONCLUSION The DeLong test indicated that the DTL-based model achieved comparable AUC compared to the classification based on PIRADS v2 score (p = 0.89).
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Affiliation(s)
- Xinran Zhong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Ruiming Cao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Computer Science, School of Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sepideh Shakeri
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Fabien Scalzo
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yeejin Lee
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dieter R Enzmann
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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17
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Hogden A, Churruca K, Rapport F, Gillatt D. Appraising risk in active surveillance of localized prostate cancer. Health Expect 2019; 22:1028-1039. [PMID: 31095822 PMCID: PMC6803412 DOI: 10.1111/hex.12912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 04/07/2019] [Accepted: 04/25/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives Men diagnosed with low‐risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active intervention. Our study examined how risk for prostate cancer is perceived and experienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care. Method Participants were nine patients and three clinicians from a university hospital urology clinic. A staged, qualitative, multi‐method data collection approach was undertaken, comprising: observations of consultations; patient and clinician interviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views. Results Thirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of “Making sense of risk”, “Talking about risk” and “Responding to risk”. Conclusion Effective risk communication needs to be finely tuned and timed to individual patient's priorities and information requirements. A structured information exchange process that identifies patients' priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient‐centric risk assessment procedures and service delivery models in prostate cancer care more broadly.
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Affiliation(s)
- Anne Hogden
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Tasmanian School of Business and Economics, Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Kate Churruca
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Gillatt
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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18
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Li W, Li J, Sarma KV, Ho KC, Shen S, Knudsen BS, Gertych A, Arnold CW. Path R-CNN for Prostate Cancer Diagnosis and Gleason Grading of Histological Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:945-954. [PMID: 30334752 PMCID: PMC6497079 DOI: 10.1109/tmi.2018.2875868] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Prostate cancer is the most common and second most deadly form of cancer in men in the United States. The classification of prostate cancers based on Gleason grading using histological images is important in risk assessment and treatment planning for patients. Here, we demonstrate a new region-based convolutional neural network framework for multi-task prediction using an epithelial network head and a grading network head. Compared with a single-task model, our multi-task model can provide complementary contextual information, which contributes to better performance. Our model is achieved a state-of-the-art performance in epithelial cells detection and Gleason grading tasks simultaneously. Using fivefold cross-validation, our model is achieved an epithelial cells detection accuracy of 99.07% with an average area under the curve of 0.998. As for Gleason grading, our model is obtained a mean intersection over union of 79.56% and an overall pixel accuracy of 89.40%.
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19
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Li J, Speier W, Ho KC, Sarma KV, Gertych A, Knudsen BS, Arnold CW. An EM-based semi-supervised deep learning approach for semantic segmentation of histopathological images from radical prostatectomies. Comput Med Imaging Graph 2018; 69:125-133. [PMID: 30243216 PMCID: PMC6173982 DOI: 10.1016/j.compmedimag.2018.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
Automated Gleason grading is an important preliminary step for quantitative histopathological feature extraction. Different from the traditional task of classifying small pre-selected homogeneous regions, semantic segmentation provides pixel-wise Gleason predictions across an entire slide. Deep learning-based segmentation models can automatically learn visual semantics from data, which alleviates the need for feature engineering. However, performance of deep learning models is limited by the scarcity of large-scale fully annotated datasets, which can be both expensive and time-consuming to create. One way to address this problem is to leverage external weakly labeled datasets to augment models trained on the limited data. In this paper, we developed an expectation maximization-based approach constrained by an approximated prior distribution in order to extract useful representations from a large number of weakly labeled images generated from low-magnification annotations. This method was utilized to improve the performance of a model trained on a limited fully annotated dataset. Our semi-supervised approach trained with 135 fully annotated and 1800 weakly annotated tiles achieved a mean Jaccard Index of 49.5% on an independent test set, which was 14% higher than the initial model trained only on the fully annotated dataset.
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Affiliation(s)
- Jiayun Li
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Computational Integrated Diagnostics, Departments of Radiological Sciences and Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - William Speier
- Computational Integrated Diagnostics, Departments of Radiological Sciences and Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - King Chung Ho
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Computational Integrated Diagnostics, Departments of Radiological Sciences and Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Karthik V Sarma
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Computational Integrated Diagnostics, Departments of Radiological Sciences and Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Arkadiusz Gertych
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beatrice S Knudsen
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Corey W Arnold
- Department of Bioengineering, University of California, Los Angeles, CA, USA; Computational Integrated Diagnostics, Departments of Radiological Sciences and Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
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20
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Medium-term Follow-up of Vascular-targeted Photodynamic Therapy of Localized Prostate Cancer Using TOOKAD Soluble WST-11 (Phase II Trials). Eur Urol Focus 2018; 5:1022-1028. [PMID: 29661587 DOI: 10.1016/j.euf.2018.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/04/2018] [Accepted: 04/01/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the medium-term tumor control in patients with localized prostate cancer (PCa) treated with vascular-targeted photodynamic (VTP) therapy with TOOKAD Soluble WST11 (VTP) and to assess the medium-term tolerability of the treatment. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION During the clinical phase II studies, 68 patients were treated with VTP under optimal treatment conditions (WST11 at 4mg/kg, light energy at 200J/cm, and a light density index ≥1) and have been included in a 3.5-yr follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Post-interventional visits were scheduled every 6 mo and conducted as per local standard practice in each study center. Cancer-free status was assessed by means of prostate-specific antigen kinetics, multiparametric magnetic resonance imaging and/or prostate biopsies. RESULTS AND LIMITATIONS At the end of the 3.5-yr follow-up, overall successful focal ablation was achieved for 51 patients (75%). Cancer was identified in the untreated lobe in 17 patients (25%). In total, 34 patients (50%) were cancer-free in both the prostate lobes. In case of recurrent/persistent malignancy, the Gleason score remained consistent or changed at the maximum by one point (upgrading by 1 Gleason point to 3+4 for eight patients and 4+3 for two patients). There were 64 related adverse events (AEs): 48% were Clavien grade I, 47% were grade II, and 5% were grade III. There were no Clavien grade IV and V AEs. Limitations included small sample size and heterogeneity in the follow-up for some centers. CONCLUSIONS VTP is a safe and efficient treatment and represents an alternative option for localized low-risk PCa management over the medium term. Precise diagnostic methods and imaging tools are thereby essential requirements to ensure safe and complete targeted therapy. PATIENT SUMMARY In this report, we looked at the medium-term outcomes of focal photodynamic therapy for early-stage prostate cancer. We found that this form of treatment is efficient and might have the potential to become a therapeutic option for low-risk cancer. Effectiveness depends on precise diagnostic methods, such as magnetic resonance imaging and accurate biopsy.
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21
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Serretta V, Abrate A, Siracusano S, Gesolfo CS, Vella M, Di Maida F, Cangemi A, Cicero G, Barresi E, Sanfilippo C. Clinical and biochemical markers of visceral adipose tissue activity: Body mass index, visceral adiposity index, leptin, adiponectin, and matrix metalloproteinase-3. Correlation with Gleason patterns 4 and 5 at prostate biopsy. Urol Ann 2018; 10:280-286. [PMID: 30089986 PMCID: PMC6060586 DOI: 10.4103/ua.ua_188_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Context: The correlation between aggressive prostate cancer and obesity mainly based on body mass index (BMI) and pathology after surgery remains controversial. Aims: The aim of the study was to correlate BMI, visceral adiposity index (VAI), and the plasmatic levels of leptin, adiponectin, and matrix metalloproteinase-3 (MMP-3), and biomarkers of adipose tissue function, with the detection of Gleason patterns 4 and 5 at biopsy. Subjects and Methods: Consecutive patients with prostate cancer at 12-core transrectal biopsy were enrolled. BMI, waist circumference (WC), blood samples to evaluate the plasmatic levels of triglycerides (TG) and high-density lipoproteins (HDL), adiponectin, leptin, and MMP-3 were obtained immediately before biopsy. The VAI was calculated according to the formula: WC/(39.68 + [1.88 × BMI]) × TG/1.03 × 1.31/HDL. Results: One hundred and forty-nine patients were entered. The median PSA, BMI, and VAI were 10.0 ng/ml, 27.6 kg/m2, and 4.6, respectively. Gleason patterns 4 or 5 were detected in 68 (45.6%) patients; in 15 (41.7%), 31 (44.9%), and 22 (50.0%) among normal weight, overweight, and obese patients, respectively (P = 0.55). The statistical analysis did not show any significant correlation between BMI, VAI, the plasmatic levels of leptin, adiponectin, MMP-3, and the detection of Gleason patterns 4 and 5 at biopsy. A statistically significant association emerged with older age (P = 0.017) and higher PSA values (P = 0.02). Conclusion: We did not find any association between BMI, VAI, the plasmatic levels of adiponectin, leptin, and MMP-3 and the detection of Gleason patterns 4 and 5 at prostate biopsy.
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Affiliation(s)
- Vincenzo Serretta
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Alberto Abrate
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Simone Siracusano
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Cristina Scalici Gesolfo
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Marco Vella
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Fabrizio Di Maida
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Antonina Cangemi
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Cicero
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
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Starobinets O, Simko JP, Kuchinsky K, Kornak J, Carroll PR, Greene KL, Kurhanewicz J, Noworolski SM. Characterization and stratification of prostate lesions based on comprehensive multiparametric MRI using detailed whole-mount histopathology as a reference standard. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3796. [PMID: 28961382 PMCID: PMC9592076 DOI: 10.1002/nbm.3796] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to characterize prostate cancer (PCa) based on multiparametric MR (mpMR) measures derived from MRI, diffusion, spectroscopy, and dynamic contrast-enhanced (DCE) MRI, and to validate mpMRI in detecting PCa and predicting PCa aggressiveness by correlating mpMRI findings with whole-mount histopathology. Seventy-eight men with untreated PCa received 3 T mpMR scans prior to radical prostatectomy. Cancerous regions were outlined, graded, and cancer amount estimated on whole-mount histology. Regions of interest were manually drawn on T2 -weighted images based on histopathology. Logistic regression was used to identify optimal combinations of parameters for the peripheral zone and transition zone to separate: (i) benign from malignant tissues; (ii) Gleason score (GS) ≤3 + 3 disease from ≥GS3 + 4; and (iii) ≤ GS3 + 4 from ≥GS4 + 3 cancers. The performance of the models was assessed using repeated fourfold cross-validation. Additionally, the performance of the logistic regression models created under the assumption that one or more modality has not been acquired was evaluated. Logistic regression models yielded areas under the curve (AUCs) of 1.0 and 0.99 when separating benign from malignant tissues in the peripheral zone and the transition zone, respectively. Within the peripheral zone, combining choline, maximal enhancement slope, apparent diffusion coefficient (ADC), and citrate measures for separating ≤GS3 + 3 from ≥GS3 + 4 PCa yielded AUC = 0.84. Combining creatine, choline, and washout slope yielded AUC = 0.81 for discriminating ≤GS3 + 4 from ≥GS4 + 3 disease. Within the transition zone, combining washout slope, ADC, and creatine yielded AUC = 0.93 for discriminating ≤GS3 + 3 and ≥GS3 + 4 cancers. When separating ≤GS3 + 4 from ≥GS4 + 3 PCa, combining choline and washout slope yielded AUC = 0.92. MpMRI provides excellent separation between benign tissues and PCa, and across PCa tissues of different aggressiveness. The final models prominently feature spectroscopy and DCE-derived metrics, underlining their value within a comprehensive mpMRI examination.
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Affiliation(s)
- Olga Starobinets
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
- Graduate Group in Bioengineering, University of California, San Francisco and Berkeley, USA
| | - Jeffry P Simko
- Department of Pathology, University of California, San Francisco, USA
- Department of Urology, University of California, San Francisco, USA
| | - Kyle Kuchinsky
- Department of Pathology, University of California, San Francisco, USA
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, USA
| | - Kirsten L Greene
- Department of Urology, University of California, San Francisco, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
- Graduate Group in Bioengineering, University of California, San Francisco and Berkeley, USA
| | - Susan M Noworolski
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
- Graduate Group in Bioengineering, University of California, San Francisco and Berkeley, USA
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Rapport F, Hogden A, Gurney H, Gillatt D, Bierbaum M, Shih P, Churruca K. Communicating risk in active surveillance of localised prostate cancer: a protocol for a qualitative study. BMJ Open 2017; 7:e017372. [PMID: 28982830 PMCID: PMC5640046 DOI: 10.1136/bmjopen-2017-017372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION One in five men is likely to receive a diagnosis of prostate cancer (PCa) by the age of 85 years. Men diagnosed with low-risk PCa may be eligible for active surveillance (AS) to monitor their cancer to ensure that any changes are discovered and responded to in a timely way. Communication of risk in this context is more complicated than determining a numerical probability of risk, as patients wish to understand the implications of risk on their lives in concrete terms. Our study will examine how risk for PCa is perceived, experienced and communicated by patients using AS with their health professionals, and the implications for treatment and care. METHODS AND ANALYSIS This is a proof of concept study, testing out a multimethod, qualitative approach to data collection in the context of PCa for the first time in Australia. It is being conducted from November 2016 to December 2017 in an Australian university hospital urology clinic. Participants are 10 men with a diagnosis of localised PCa, who are using an AS protocol, and 5 health professionals who work with this patient group (eg, urologists and Pca nurses). Data will be collected using observations of patient consultations with health professionals, patient questionnaires and interviews, and interviews with healthcare professionals. Analysis will be conducted in two stages. First, observational data from consultations will be analysed thematically to encapsulate various dimensions of risk classification and consultation dialogue. Second, interview data will be coded to derive meaning in text and analysed thematically. Overarching themes will represent patient and health professional perspectives of risk communication. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by Macquarie University Human Research Ethics Committee, approval 5201600638. Knowledge translation will be achieved through publications, reports and conference presentations to patients, families, clinicians and researchers.
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Affiliation(s)
- Frances Rapport
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Anne Hogden
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Gillatt
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Patti Shih
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Stefanovski D, Tang G, Wawrowsky K, Boston RC, Lambrecht N, Tajbakhsh J. Prostate cancer diagnosis using epigenetic biomarkers, 3D high-content imaging and probabilistic cell-by-cell classifiers. Oncotarget 2017; 8:57278-57301. [PMID: 28915670 PMCID: PMC5593641 DOI: 10.18632/oncotarget.18985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Background Prostate cancer (PCa) management can benefit from novel concepts/biomarkers for reducing the current 20-30% chance of false-negative diagnosis with standard histopathology of biopsied tissue. Method We explored the potential of selected epigenetic markers in combination with validated histopathological markers, 3D high-content imaging, cell-by-cell analysis, and probabilistic classification in generating novel detailed maps of biomarker heterogeneity in patient tissues, and PCa diagnosis. We used consecutive biopsies/radical prostatectomies from five patients for building a database of ∼140,000 analyzed cells across all tissue compartments and for model development; and from five patients and the two well-characterized HPrEpiC primary and LNCaP cancer cell types for model validation. Results Principal component analysis presented highest covariability for the four biomarkers 4′,6-diamidino-2-phenylindole, 5-methylcytosine, 5-hydroxymethylcytosine, and alpha-methylacyl-CoA racemase in the epithelial tissue compartment. The panel also showed best performance in discriminating between normal and cancer-like cells in prostate tissues with a sensitivity and specificity of 85%, correctly classified 87% of HPrEpiC as healthy and 99% of LNCaP cells as cancer-like, identified a majority of aberrant cells within histopathologically benign tissues at baseline diagnosis of patients that were later diagnosed with adenocarcinoma. Using k-nearest neighbor classifier with cells from an initial patient biopsy, the biomarkers were able to predict cancer stage and grade of prostatic tissue that occurred at later prostatectomy with 79% accuracy. Conclusion Our approach showed favorable diagnostic values to identify the portion and pathological category of aberrant cells in a small subset of sampled tissue cells, correlating with the degree of malignancy beyond baseline.
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Affiliation(s)
- Darko Stefanovski
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - George Tang
- Translational Cytomics Group, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kolja Wawrowsky
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raymond C Boston
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nils Lambrecht
- Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Long Beach, CA, USA.,Department of Pathology and Laboratory Medicine, University of California Irvine, Orange, CA, USA
| | - Jian Tajbakhsh
- Translational Cytomics Group, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Broe MP, Forde JC, Inder MS, Galvin DJ, Mulvin DW, Quinlan DM. The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes? Ir J Med Sci 2017; 186:583-588. [PMID: 28281040 DOI: 10.1007/s11845-017-1583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP). METHODS A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4 + 3 versus G3 + 4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage. RESULTS In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4 + 3 and 97 graded G3 + 4). Since the introduction of RAPC the proportion of G4 + 3 compared to G3 + 4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4 + 3 treated before and after the introduction of RAPC. G4 + 3 was associated with higher rates of BCR (24.4 vs. 0%, p < 0.0001, radiotherapy (41.1 vs. 4.8%, p < 0.0001) and worse histological features than G3 + 4. CONCLUSION Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4 + 3 disease.
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Affiliation(s)
- M P Broe
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - J C Forde
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - M S Inder
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D J Galvin
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D W Mulvin
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D M Quinlan
- Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland
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Atala A. Re: Integrated Classification of Prostate Cancer Reveals a Novel Luminal Subtype with Poor Outcome. J Urol 2017; 197:701-702. [DOI: 10.1016/j.juro.2016.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Palapattu GS, Salami SS, Cani AK, Hovelson DH, Lazo de la Vega L, Vandenberg KR, Bratley JV, Liu CJ, Kunju LP, Montgomery JS, Morgan TM, Natarajan S, Huang J, Tomlins SA, Marks LS. Molecular Profiling to Determine Clonality of Serial Magnetic Resonance Imaging/Ultrasound Fusion Biopsies from Men on Active Surveillance for Low-Risk Prostate Cancer. Clin Cancer Res 2017; 23:985-991. [PMID: 28031426 PMCID: PMC5315613 DOI: 10.1158/1078-0432.ccr-16-1454] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/21/2016] [Accepted: 09/11/2016] [Indexed: 12/19/2022]
Abstract
Purpose: To determine whether MRI/ultrasound (MRI/US) fusion biopsy facilitates longitudinal resampling of the same clonal focus of prostate cancer and to determine whether high-grade cancers can evolve from low-grade clones.Experimental Design: All men on active surveillance who underwent tracking MRI/US fusion biopsy of Gleason 6 prostate cancer, on at least two distinct occasions, between 2012 and 2014 were enrolled. MRI/US fusion was used to track and resample specific cancer foci. IHC for ERG and targeted RNA/DNA next-generation sequencing (NGS) were performed on formalin-fixed paraffin-embedded prostate biopsy specimens to assess clonality.Results: Thirty-one men with median age and PSA of 65 years and 4.6 ng/mL, respectively, were analyzed. The median sampling interval was 12 months (range, 5-35). Of the 26 evaluable men, ERG IHC concordance was found between initial and repeat biopsies in 25 (96%), indicating resampling of the same clonal focus over time. Targeted NGS supported ERG IHC results and identified unique and shared driving mutations, such as IDH1 and SPOP, in paired specimens. Of the nine men (34.6%) who were found to have Gleason ≥7 on repeat biopsy, all displayed temporal ERG concordance. Prioritized genetic alterations were detected in 50% (13/26) of paired samples. Oncogenic mutations were detected in 22% (2/9) of Gleason 6 cancers prior to progression and 44% (4/9) of Gleason ≥7 cancers when progression occurred.Conclusions: Precise tracking of prostate cancer foci via MRI/US fusion biopsy allowed subsequent resampling of the same clonal focus of cancer over time. Further research is needed to clarify the grade progression potential of Gleason 6 prostate cancer. Clin Cancer Res; 23(4); 985-91. ©2016 AACR.
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Affiliation(s)
- Ganesh S Palapattu
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Andi K Cani
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Daniel H Hovelson
- Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Lorena Lazo de la Vega
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Kelly R Vandenberg
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jarred V Bratley
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Chia-Jen Liu
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Lakshmi P Kunju
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jeffery S Montgomery
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Scott A Tomlins
- Department of Urology, University of Michigan, Ann Arbor, Michigan.
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Leapman MS, Carroll PR. What is the best way not to treat prostate cancer? Urol Oncol 2016; 35:42-50. [PMID: 27746147 DOI: 10.1016/j.urolonc.2016.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Selective treatment approaches for prostate cancer (PCa) are warranted given the highly varied nature of the disease and the consequences associated with definitive therapy. MATERIALS AND METHODS We present a stepwise overview of strategies optimized to not treat PCa, ranging from improved screening practices that seek to maximize the yield at initial diagnosis, as well as refinements to clinical risk prediction and the performance of active surveillance. RESULTS Improved adherence to screening guidelines offering simplistic, rational practice recommendations are poised to improve the performance of early detection strategies. In addition, measures to improve the quality of PCa screening would include greater integration of novel markers with higher specificity for clinically significant disease, in an effort to stem the tide of over-diagnosis and consequential overtreatment of low-grade tumors. For men diagnosed with PCa, the use of validated, multi-variable risk stratification stands to offer greater certainty in initial management choices: consideration of active surveillance for those with low-risk status, and definitive therapy for men with intermediate and high-risk features. We review the efficacy and nature of active surveillance protocols, and offer a context for refinements that may be anticipated with future study. CONCLUSIONS The question of how best to not treat prostate cancer is often more complex than policies of universal treatment, yet is integral to minimize morbidity of over-treatment in patients with low-risk tumors. An array of refined risk stratification instruments, biomarkers, and genomic assays seek to improve the confidence both prior to, and following diagnosis.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT.
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA
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Trama A, Botta L, Nicolai N, Rossi PG, Contiero P, Fusco M, Lodde M, Pannozzo F, Piffer S, Puppo A, Seeber A, Tumino R, Valdagni R, Gatta G. Prostate cancer changes in clinical presentation and treatments in two decades: an Italian population-based study. Eur J Cancer 2016; 67:91-98. [PMID: 27620947 DOI: 10.1016/j.ejca.2016.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/22/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The incidence of prostate cancer is on the rise in many industrialised countries, including Italy, most likely because of the spread of PSA testing. In Italy, prostate cancer mortality has been dropping since 2000, but it is difficult to understand whether PSA testing is the main reason, considering the role of treatment in prognosis. The objectives of this study were: (1) to describe Italian trends of prostate cancer risk categories and corresponding changes in treatment patterns and (2) to interpret changes in survival over time. METHODS We made a retrospective observational study using population-based cancer registries. We examined two periods, 1996-1999 and 2005-2007, analysing the distribution of patients among risk groups and treatment changes in those intervals. We estimated 7- and 15-year relative survival with the cohort approach, Ederer II method. We analysed 4635 cases. RESULTS There was downward risk migration from the first to the second period. In patients younger than 75 years, there was an increase in radical prostatectomy but not radiotherapy; patients older than 75 years rarely had treatment with radical intent. We noted an improvement of prostate cancer survival in the high-risk group. CONCLUSION These findings raise several questions: the possible overtreatment of low-risk patients undergoing radical treatment; the utility of more aggressive treatment for elderly patients with high-risk disease; and the importance of a multidisciplinary clinical approach to ensure multiple and alternative treatment options. The increase in survival, with the decrease in mortality, suggests an effect of radical treatments on prognosis.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy; Arcispedale S. Maria Nuova, IRCCS Reggio Emilia, Viale Umberto I 50, 42123 Reggio Emilia, Italy.
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
| | - Mario Fusco
- Registro Tumori Asl Napoli 3 Sud, Piazza San Giovanni, 80031 Brusciano, NA, Italy.
| | - Michele Lodde
- Department of Urology, Central Hospital of Bolzano, Via Loren Boeler 5, 39100 Bolzano, Italy.
| | - Fabio Pannozzo
- Registro Tumori della Provincia di Latina, Viale P. Nervi, Centro Latina Fiori, 04100 Latina, Italy.
| | - Silvano Piffer
- Servizio epidemiologia clinica e valutativa, Registro Tumori della Provincia di Trento, viale Verona, 38100 Trento, Italy.
| | - Antonella Puppo
- Registro Tumori Ligure, Epidemiologia Clinica IRCCS AOU San Martino, IST Genova Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Andreas Seeber
- Department for Haematology and Oncology, Tyrolean Cancer Research Institute, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP Via Dante 109, Ragusa, Italy.
| | - Riccardo Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; Prostate Cancer Program and Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy.
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Miah S, Ahmed HU, Freeman A, Emberton M. Does true Gleason pattern 3 merit its cancer descriptor? Nat Rev Urol 2016; 13:541-8. [DOI: 10.1038/nrurol.2016.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nnabugwu II, Udeh EI, Ugwumba FO, Ozoemena FO. Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria. Clin Interv Aging 2016; 11:961-6. [PMID: 27486316 PMCID: PMC4957636 DOI: 10.2147/cia.s98232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. Patients and methods The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher’s exact test was used for categorical variables. Significance was set at P≤0.05. Results There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. Conclusion GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.
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Affiliation(s)
- Ikenna I Nnabugwu
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Emeka I Udeh
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Fredrick O Ugwumba
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
| | - Francis O Ozoemena
- Urology Unit, Department of Surgery, College of Medicine, Enugu Campus, University of Nigeria, Enugu, Nigeria
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Packer JR, Maitland NJ. The molecular and cellular origin of human prostate cancer. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2016; 1863:1238-60. [DOI: 10.1016/j.bbamcr.2016.02.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 01/01/2023]
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Helpap B, Ringli D, Tonhauser J, Poser I, Breul J, Gevensleben H, Seifert HH. The Significance of Accurate Determination of Gleason Score for Therapeutic Options and Prognosis of Prostate Cancer. Pathol Oncol Res 2015; 22:349-56. [PMID: 26563277 DOI: 10.1007/s12253-015-0013-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/04/2015] [Indexed: 11/28/2022]
Abstract
The Gleason score (GS) to date remains one of the most reliable prognostic predictors in prostate cancer (PCa). However, the majority of studies supporting its prognostic relevance were performed prior to its modification by the International Society of Urological Pathology (ISUP) in 2005. Furthermore, the combination of Gleason grading and nuclear/nucleolar subgrading (Helpap score) has been shown to essentially improve grading concordance between biopsy and radical prostatectomy (RP) specimens. This prompted us to investigate the modified GS and combigrading (Gleason/Helpap score) in association with clinicopathological features, biochemical recurrence (BCR), and survival. Core needle biopsies and corresponding RP specimens from 580 patients diagnosed with PCa between 2005 and 2010 were evaluated. According to the modified GS, the comparison between biopsy and RP samples resulted in an upgrading from GS 6 to GS 7a and GS 7b in 65% and 19%, respectively. Combigrading further resulted in an upgrading from low grade (GS 6/2a) to intermediate grade PCa (GS 6/2b) in 11.1% and from intermediate grade (GS 6/2b) to high grade PCa (GS 7b/2b) in 22.6%. Overall, well-differentiated PCa (GS 6/2a) was detected in 2.8% of RP specimens, while intermediate grade (GS 6/2b and GS 7a/2b) and high grade cancers (≥ GS 7b) accounted for 39.5% and 57.4% of cases, respectively. At a mean follow-up of 3.9 years, BCR was observed in 17.6% of patients with intermediate (9.8%) or high grade PCa (30.2%), while PSA relapse did not occur in GS 6/2a PCa. In conclusion, adding nuclear/nucleolar subgrading to the modified GS allowed for a more accurate distinction between low and intermediate grade PCa, therefore offering a valuable tool for the identification of patients eligible for active surveillance (AS).
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Affiliation(s)
- Burkhard Helpap
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany.
| | - Daniel Ringli
- Department of Pathology, Hegau-Bodensee Hospital of Singen, PO Box 720, 78207, Singen, Germany
| | - Jens Tonhauser
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
| | - Immanuel Poser
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | - Jürgen Breul
- Department of Urology and Urologic Oncology, Loretto Hospital, Freiburg, Germany
| | | | - Hans-Helge Seifert
- Department of Urology, Hegau-Bodensee Hospital of Singen, Singen, Germany
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Automatic classification of prostate cancer Gleason scores from multiparametric magnetic resonance images. Proc Natl Acad Sci U S A 2015; 112:E6265-73. [PMID: 26578786 DOI: 10.1073/pnas.1505935112] [Citation(s) in RCA: 258] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Noninvasive, radiological image-based detection and stratification of Gleason patterns can impact clinical outcomes, treatment selection, and the determination of disease status at diagnosis without subjecting patients to surgical biopsies. We present machine learning-based automatic classification of prostate cancer aggressiveness by combining apparent diffusion coefficient (ADC) and T2-weighted (T2-w) MRI-based texture features. Our approach achieved reasonably accurate classification of Gleason scores (GS) 6(3 + 3) vs. ≥7 and 7(3 + 4) vs. 7(4 + 3) despite the presence of highly unbalanced samples by using two different sample augmentation techniques followed by feature selection-based classification. Our method distinguished between GS 6(3 + 3) and ≥7 cancers with 93% accuracy for cancers occurring in both peripheral (PZ) and transition (TZ) zones and 92% for cancers occurring in the PZ alone. Our approach distinguished the GS 7(3 + 4) from GS 7(4 + 3) with 92% accuracy for cancers occurring in both the PZ and TZ and with 93% for cancers occurring in the PZ alone. In comparison, a classifier using only the ADC mean achieved a top accuracy of 58% for distinguishing GS 6(3 + 3) vs. GS ≥7 for cancers occurring in PZ and TZ and 63% for cancers occurring in PZ alone. The same classifier achieved an accuracy of 59% for distinguishing GS 7(3 + 4) from GS 7(4 + 3) occurring in the PZ and TZ and 60% for cancers occurring in PZ alone. Separate analysis of the cancers occurring in TZ alone was not performed owing to the limited number of samples. Our results suggest that texture features derived from ADC and T2-w MRI together with sample augmentation can help to obtain reasonably accurate classification of Gleason patterns.
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Ta AD, Papa NP, Lawrentschuk N, Millar JL, Syme R, Giles GG, Bolton DM. Increased prostate cancer specific mortality following radical prostatectomy in men presenting with voiding symptoms-A whole of population study. Prostate Int 2015; 3:75-9. [PMID: 26473148 PMCID: PMC4588378 DOI: 10.1016/j.prnil.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/04/2015] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Whole of population studies reporting long-term outcomes following radical prostatectomy (RP) are scarce. We aimed to evaluate the long-term outcomes in men with prostate cancer (PC) treated with RP in a whole of population cohort. A secondary objective was to evaluate the influence of mode of presentation on PC specific mortality (PCSM). METHODS A prospective database of all cases of RP performed in Victoria, Australia between 1995 and 2000 was established within the Victorian Cancer Registry. Specimen histopathology reports and prostate-specific antigen (PSA) values were obtained by record linkage to pathology laboratories. Mode of presentation was recorded as either PSA screened (PSA testing offered in absence of voiding symptoms) or symptomatic (diagnosis of PC following presentation with voiding symptoms). Multivariate Cox and competing risk regression models were fitted to analyze all-cause mortality, biochemical recurrence, and PCSM. RESULTS Between 1995 and 2000, 2,154 men underwent RP in Victoria. During median follow up of 10.2 years (range 0.26-13.5 years), 74 men died from PC. In addition to Gleason score and pathological stage, symptomatic presentation was associated with PCSM. After adjusting for stage and PSA, no difference in PCSM was found between men with Gleason score ≤ 6 and Gleason score 3 + 4 = 7. Men with Gleason score 4 + 3 had significantly greater cumulative incidence of PCSM compared with men with Gleason score 3 + 4. CONCLUSIONS Primary Gleason pattern in Gleason 7 PC is an important prognosticator of survival. Our findings suggest that concomitant voiding symptoms should be considered in the work-up and treatment of PC.
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Affiliation(s)
- Anthony D Ta
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Nathan P Papa
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia ; Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia ; Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Australia ; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeremy L Millar
- William Buckland Centre, The Alfred Hospital, Melbourne, Australia
| | - Rodney Syme
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
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Soga N, Yatabe Y, Kageyama T, Ogura Y, Hayashi N. Review of Bioptic Gleason Scores by Central Pathologist Modifies the Risk Classification in Prostate Cancer. Urol Int 2015; 95:452-6. [DOI: 10.1159/000439440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022]
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Multiparametric MRI of the prostate at 3 T: limited value of 3D 1H-MR spectroscopy as a fourth parameter. World J Urol 2015; 34:649-56. [DOI: 10.1007/s00345-015-1670-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022] Open
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Siadat F, Sykes J, Zlotta AR, Aldaoud N, Egawa S, Pushkar D, Kuk C, Bristow RG, Montironi R, van der Kwast T. Not all gleason pattern 4 prostate cancers are created equal: A study of latent prostatic carcinomas in a cystoprostatectomy and autopsy series. Prostate 2015; 75:1277-84. [PMID: 25963383 DOI: 10.1002/pros.23009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value. METHODS We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded. RESULTS The prevalence of Gleason score ≥ 7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015). DISCUSSION Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology.
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Affiliation(s)
- Farshid Siadat
- Department of Anatomical Pathology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jenna Sykes
- Biostatistics, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Alexandre R Zlotta
- Department of Surgery, Division of Urology, Mount Sinai Hospital and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Najla Aldaoud
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Dmitry Pushkar
- Department of Urology, University of Moscow, Moscow, Russia
| | - Cynthia Kuk
- Department of Surgery, Division of Urology, Mount Sinai Hospital and Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Robert G Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Rodolfo Montironi
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Theodorus van der Kwast
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, Ontario, Canada
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Mahal BA, Muralidhar V, Chen YW, Choueiri TK, Hoffman KE, Hu JC, Sweeney CJ, Yu JB, Feng FY, Trinh QD, Nguyen PL. Gleason score 5 + 3 = 8 prostate cancer: much more like Gleason score 9? BJU Int 2015. [DOI: 10.1111/bju.13239] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Brandon A. Mahal
- Department of Internal Medicine; Brigham and Women's Hospital; Boston MA USA
| | | | - Yu-Wei Chen
- Harvard School of Public Health; Boston MA USA
| | - Toni K. Choueiri
- Department of Medical Oncology; Dana-Farber Cancer Institute and Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Karen E. Hoffman
- Department of Radiation Oncology; MD Anderson Cancer Center; The University of Texas; Boston MA USA
| | - Jim C. Hu
- Department of Urology; UCLA Medical Center; Los Angeles CA USA
| | - Christopher J. Sweeney
- Department of Medical Oncology; Dana-Farber Cancer Institute and Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - James B. Yu
- Department of Therapeutic Radiology/Radiation Oncology; Yale; New Haven CT USA
| | - Felix Y. Feng
- Department of Radiation Oncology; University of Michigan Health System; Ann Arbor MI USA
| | - Quoc-Dien Trinh
- Division of Urology; Brigham and Women's Hospital; Boston MA USA
| | - Paul L. Nguyen
- Department of Radiation Oncology; Dana-Farber Cancer Institute and Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Abstract
PUPOSE OF REVIEW The review covers arguments for and against removing the label of 'cancer' in Gleason score 6 prostate tumors. RECENT FINDINGS While there are a number of factors that determine whether men elect active surveillance, the most powerful predictor remains the Gleason score. Gleason grading remains a robust and powerful predictor of outcome in patients with prostate cancer. A pure Gleason score 6 (GS6) tumor is exceedingly unlikely to cause harm in the near term, and there have been discussions regarding whether the term cancer should still be applied. In this review, we update the largely clinico-pathological arguments that have led to the suggestion to remove the cancer label from GS6 tumors, and we provide counter arguments on the basis of practical matters of needle biopsy sampling, classical histopathology, and molecular biology findings. SUMMARY The implications are that by retaining the label of cancer and implementing the recently proposed concept of prognostic groups, with patients harboring GS6 tumors placed into the lowest category, there is still a strong rationale in support of the choice of active surveillance or watchful waiting for most patients with GS6 lesions.
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Affiliation(s)
- Ibrahim Kulac
- aDepartment of Pathology bDepartment of Urology cDepartment of Oncology dThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins eThe Brady Urological Research Institute
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Earlier prostate-specific antigen testing in African American men--Clinical support for the recommendation. Urol Oncol 2015; 33:330.e9-17. [PMID: 25937424 DOI: 10.1016/j.urolonc.2015.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/14/2015] [Accepted: 03/21/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND To determine whether prostate-specific antigen (PSA) testing in African American veterans (AAVs) aged 40 to 54 years is associated with high-risk prostate cancer characteristics compared with AAVs aged 55 to 70 years or white veterans (WVs) aged 40 to 54 years. METHODS A total of 231,174 healthy veterans aged 40 to 70 years without clinical evidence of prostate cancer underwent PSA testing between October 1, 2000, and September 30, 2007. Clinicopathologic tumor characteristics were available for 1,044/1,059 AAVs and 1,006/1,971 age-matched WVs diagnosed with prostate cancer after a PSA level>4 ng/ml triggered prostate biopsy. Tumor characteristics of AAVs aged 40 to 54 years were compared with AAVs 55 to 70 years, WVs 40 to 54 years, and WVs 55 to 70 years. RESULTS Of PSA-tested veterans aged 40 to 54 years diagnosed with prostate cancer, there were no racial differences in prebiopsy PSA levels, prostate cancer grade, or clinical stage at diagnosis. AAVs aged 40 to 54 years were more likely to have ≥ 3 positive cores (P = 0.0229) and were less likely to be active surveillance candidates (P = 0.0340) compared with similarly aged WVs. AAVs aged 55 to 70 years were more likely to have high-grade (P = 0.0204) and higher clinical stage (P = 0.0195) prostate cancer than AAVs aged 40 to 54 years. CONCLUSIONS This large national cohort study suggests that PSA testing at an earlier age for African American men may allow diagnosis of lower risk prostate cancer, potentially reducing disparate outcomes between AAVs and WVs.
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Rosenkrantz AB, Pysarenko K. The service encounter in radiology: acing the "moments of truth" to achieve patient-centered care. Acad Radiol 2015; 22:259-64. [PMID: 25572928 DOI: 10.1016/j.acra.2014.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/25/2022]
Abstract
Radiologists are increasingly recognizing their role as direct service providers to patients and seeking to offer an exceptional patient experience as part of high-quality service delivery. Patients' perceptions of service delivery are derived from the chain of numerous individual real-time encounters that occur throughout their visit. These so-called "moments of truth" define the overall experience and form the lasting impression of the given practice in their mind. Providing excellent service can be difficult to achieve in practice given its intangible nature as well as the heterogeneity and unpredictability of the large number of patients, frontline staff, and environmental circumstances that define the patient experience. Thus, broad commitment and team effort among all members of a radiology practice are required. This article explores important areas to be considered by a radiology practice to ensure positive and meaningful patient experiences. Specific ways in which every member within the practice, including schedulers, receptionists, technologists, nurses, and radiologists, can contribute to achieving high-quality patient service are discussed. Examples of patient-oriented language that may be useful in particular scenarios in radiology practice are given. The role of the practice's physical facility, including all aspects of its aesthetics and amenities, as well as of Internet services, in shaping the patient experience is also described. Throughout this work, a proactive approach to promoting a service-oriented organizational culture is provided. By improving the patient experience, these strategies may serve to enhance patients' perceptions of radiology and radiologists.
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Lee JJ, Thomas IC, Nolley R, Ferrari M, Brooks JD, Leppert JT. Biologic differences between peripheral and transition zone prostate cancer. Prostate 2015; 75:183-90. [PMID: 25327466 PMCID: PMC4270836 DOI: 10.1002/pros.22903] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/25/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prostate cancer arises in the transition zone (TZ) in approximately 20-25% of cases. Modern biopsy and surveillance protocols, and advances in prostate cancer imaging, have renewed interest in TZ prostate cancers. We compared TZ and PZ prostate cancer to determine if cancer location is independently associated with better outcomes. METHODS We evaluated an expanded cohort of 1354 men who underwent radical prostatectomy between 1983 and 2003 with updated long-term clinical follow-up. Regression models were used to compare the volume of high-grade (Gleason 4 or 5) cancer and total cancer volume by location. Uni- and multi-variable logistic regression models tested the associations between cancer location and adverse pathologic features. Multivariable proportional hazard models were fit to examine cancer recurrence. RESULTS Patients with TZ cancer presented with higher pre-operative serum PSA values (11.07 vs. 7.86 ng/ml) and larger total cancer volume (7.1 vs. 3.8 cc). Patients with TZ cancer had decreased odds of seminal vesicle invasion (OR 0.08, 95% CI 0.03, 0.21), extra-capsular extension (OR 0.56, 95% CI 0.35, 0.92), and lymphovascular invasion (OR 0.48, 95% CI 0.27, 0.87) in multivariable models. TZ cancers were independently associated with decreased hazard of tumor recurrence (HR 0.62, 95% CI 0.43, 0.90). CONCLUSIONS TZ cancer prostate is associated with favorable pathologic features and better recurrence-free survival despite being diagnosed with larger cancers and higher PSA values. Tumor location should be taken into account when stratifying patient risk before and after prostatectomy, particularly with the evolving role of imaging in prostate cancer management.
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Affiliation(s)
- J Joy Lee
- Department of Urology, Stanford University School of Medicine, Stanford, California
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Long Q, Xu J, Osunkoya AO, Sannigrahi S, Johnson BA, Zhou W, Gillespie T, Park JY, Nam RK, Sugar L, Stanimirovic A, Seth AK, Petros JA, Moreno CS. Global transcriptome analysis of formalin-fixed prostate cancer specimens identifies biomarkers of disease recurrence. Cancer Res 2014; 74:3228-37. [PMID: 24713434 DOI: 10.1158/0008-5472.can-13-2699] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Prostate cancer remains the second leading cause of cancer death in American men and there is an unmet need for biomarkers to identify patients with aggressive disease. In an effort to identify biomarkers of recurrence, we performed global RNA sequencing on 106 formalin-fixed, paraffin-embedded prostatectomy samples from 100 patients at three independent sites, defining a 24-gene signature panel. The 24 genes in this panel function in cell-cycle progression, angiogenesis, hypoxia, apoptosis, PI3K signaling, steroid metabolism, translation, chromatin modification, and transcription. Sixteen genes have been associated with cancer, with five specifically associated with prostate cancer (BTG2, IGFBP3, SIRT1, MXI1, and FDPS). Validation was performed on an independent publicly available dataset of 140 patients, where the new signature panel outperformed markers published previously in terms of predicting biochemical recurrence. Our work also identified differences in gene expression between Gleason pattern 4 + 3 and 3 + 4 tumors, including several genes involved in the epithelial-to-mesenchymal transition and developmental pathways. Overall, this study defines a novel biomarker panel that has the potential to improve the clinical management of prostate cancer.
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Affiliation(s)
- Qi Long
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jianpeng Xu
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Adeboye O Osunkoya
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department o
| | - Soma Sannigrahi
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Brent A Johnson
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Wei Zhou
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department o
| | - Theresa Gillespie
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jong Y Park
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Robert K Nam
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Linda Sugar
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Aleksandra Stanimirovic
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Arun K Seth
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - John A Petros
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department o
| | - Carlos S Moreno
- Authors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, OntarioAuthors' Affiliations: Departments of Biomedical Informatics, Biostatistics and Bioinformatics, Pathology and Laboratory Medicine, Urology, Hematology and Medical Oncology, Human Genetics, and Surgery; Winship Cancer Institute, Emory University, Atlanta; Atlanta VA Medical Center, Decatur, Georgia; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida; Department of Laboratory Medicine and Pathobiology, University of Toronto; and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Lichtensztajn DY, Gomez SL, Sieh W, Chung BI, Cheng I, Brooks JD. Prostate cancer risk profiles of Asian-American men: disentangling the effects of immigration status and race/ethnicity. J Urol 2014; 191:952-6. [PMID: 24513166 PMCID: PMC4051432 DOI: 10.1016/j.juro.2013.10.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Asian-American men with prostate cancer have been reported to present with higher grade and later stage disease than white American men. However, Asian-American men comprise a heterogeneous population with distinct health outcomes. We compared prostate cancer risk profiles among the diverse racial and ethnic groups in California. MATERIALS AND METHODS We used data from the California Cancer Registry on 90,845 nonHispanic white, nonHispanic black and Asian-American men diagnosed with prostate cancer between 2004 and 2010. Patients were categorized into low, intermediate and high risk groups based on clinical stage, Gleason score and prostate specific antigen at diagnosis. Using polytomous logistic regression we estimated adjusted ORs for the association of race/ethnicity and nativity with risk group. RESULTS In addition to the nonHispanic black population, 6 Asian-American groups (United States born Chinese, foreign born Chinese, United States born Japanese, foreign born Japanese, foreign born Filipino and foreign born Vietnamese) were more likely to have an unfavorable risk profile compared to nonHispanic white men. The OR for high vs intermediate risk disease ranged from 1.23 (95% CI 1.02-1.49) for United States born Japanese men to 1.45 (95% CI 1.31-1.60) for foreign born Filipino men. These associations appeared to be driven by higher grade and prostate specific antigen rather than by advanced clinical stage at diagnosis. CONCLUSIONS In this large, ethnically diverse, population based cohort Asian-American men were more likely to have an unfavorable risk profile at diagnosis. This association varied by racial/ethnic group and nativity, and was not attributable to later stage at diagnosis. This suggests that Asian men may have biological differences that predispose to more severe disease.
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Affiliation(s)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California; Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Weiva Sieh
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
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Rosenkrantz AB, Triolo MJ, Melamed J, Rusinek H, Taneja SS, Deng FM. Whole-lesion apparent diffusion coefficient metrics as a marker of percentage Gleason 4 component within Gleason 7 prostate cancer at radical prostatectomy. J Magn Reson Imaging 2014; 41:708-14. [PMID: 24616064 DOI: 10.1002/jmri.24598] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/25/2014] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To retrospectively assess the utility of whole-lesion apparent diffusion coefficient (ADC) metrics in characterizing the Gleason 4 component of Gleason 7 prostate cancer (PCa) at radical prostatectomy. MATERIALS AND METHODS Seventy patients underwent phased-array coil 3T-magnetic resonance imaging (MRI) before prostatectomy. A uropathologist mapped locations and Gleason 4 percentage (G4%) of Gleason 7 tumors. Two radiologists independently reviewed ADC maps, aware of tumor locations but not G4%, and placed a volume-of-interest (VOI) on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC and ADC entropy. Entropy reflects textural variation and increases with greater macroscopic heterogeneity. Performance for characterizing Gleason 7 tumors was assessed with mixed-model analysis of variance (ANOVA) and logistic regression. RESULTS Among 84 Gleason 7 tumors (G4% 5%-85%, median 30%; 59 Gleason 3+4, 25 Gleason 4+3), ADC entropy was significantly higher in Gleason 4+3 than Gleason 3+4 tumors (R1: 5.27 ± 0.61 vs. 4.62 ± 0.78, P = 0.001; R2: 5.91 ± 0.32 vs. 5.57 ± 0.56, P = 0.004); mean ADC was not significantly different between these groups (R1: 0.90 ± 0.15*10(-3) cm(2) /s vs. 0.98 ± 0.21*10(-3) cm(2) /s, P = 0.075; R2: 1.06 ± 0.19*10(-3) cm(2) /s vs. 1.14 ± 0.16*10(-3) cm(2) /s, P = 0.083). The area under the receiver operating characteristic (ROC) curve (AUC) for differentiating groups was significantly higher with ADC entropy than mean ADC for one observer (R1: 0.74 vs. 0.57, P = 0.027; R2: 0.69 vs. 0.61, P = 0.329). For R1, correlation with G4% was moderate for ADC entropy (r = 0.45) and weak for mean ADC (r = -0.25). For R2, correlation with G4% was moderate for ADC entropy (r = 0.41) and mean ADC (r = -0.32). For both readers, ADC entropy (P = 0.028-0.003), but not mean ADC (P = 0.384-0.854), was a significant independent predictor of G4%. CONCLUSION Whole-lesion ADC entropy outperformed mean ADC in characterizing Gleason 7 tumors and may help refine prognosis for this heterogeneous PCa subset.
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Penney KL, Stampfer MJ, Jahn JL, Sinnott JA, Flavin R, Rider JR, Finn S, Giovannucci E, Sesso HD, Loda M, Mucci LA, Fiorentino M. Gleason grade progression is uncommon. Cancer Res 2014; 73:5163-8. [PMID: 23946472 DOI: 10.1158/0008-5472.can-13-0427] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gleason grade is universally used for pathologic scoring of the differentiation of prostate cancer. However, it is unknown whether prostate tumors arise well differentiated and then progress to less differentiated forms or if Gleason grade is an early and largely unchanging feature. Prostate-specific antigen (PSA) screening has reduced the proportion of tumors diagnosed at advanced stage, which allows assessment of this question on a population level. If Gleason grade progresses as stage does, one would expect a similar reduction in high-grade tumors. We studied 1,207 Physicians' Health Study and Health Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. We compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. We re-reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced stage tumors dropped more than six-fold, from the earliest period (12/1982-1/1993), 19.9% stage ≥ T3, to the latest (5/2000-12/2004), 3% stage T3, none T4. The proportion of Gleason score ≥ 8 decreased substantially less, from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade (P = 0.04) suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumor pathogenesis. This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance.
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Affiliation(s)
- Kathryn L Penney
- Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Simmons LAM, Ahmed HU, Moore CM, Punwani S, Freeman A, Hu Y, Barratt D, Charman SC, Van der Meulen J, Emberton M. The PICTURE study -- prostate imaging (multi-parametric MRI and Prostate HistoScanning™) compared to transperineal ultrasound guided biopsy for significant prostate cancer risk evaluation. Contemp Clin Trials 2013; 37:69-83. [PMID: 24291455 DOI: 10.1016/j.cct.2013.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The primary objective of the PICTURE study is to assess the negative predictive value of multi-parametric MRI (mp-MRI) and Prostate HistoScanning™ (PHS) in ruling-out clinically significant prostate cancer. PATIENTS AND METHODS PICTURE is a prospective diagnostic validating cohort study conforming to level 1 evidence. PICTURE will assess the diagnostic performance of multi-parametric Magnetic Resonance Imaging (mp-MRI) and Prostate HistoScanning™ (PHS) ultrasound. PICTURE will involve validating both index tests against a reference test, transperineal Template Prostate Mapping (TPM) biopsies, which can be applied in all men under evaluation. Men will be blinded to the index test results and both index tests will be reported prospectively prior to the biopsies being taken to ensure reporter blinding. Paired analysis of each of the index tests to the reference test will be done at patient level. Those men with an imaging lesion will undergo targeted biopsies to assess the clinical utility of sampling only suspicious areas. The study is powered to assess the negative predictive value of these imaging modalities in ruling-out clinically significant prostate cancer. DISCUSSION The PICTURE study aims to assess the performance characteristics of two imaging modalities (mp-MRI and Prostate HistoScanning) for their utility in the prostate cancer pathway. PICTURE aims to identify if either imaging test may be useful for ruling out clinically significant disease in men under investigation, and also to examine if either imaging modality is useful for the detection of disease. Recruitment is underway and expected to complete in 2014.
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Affiliation(s)
- Lucy A M Simmons
- Division of Surgery and Interventional Science, University College London, UK.
| | - Hashim Uddin Ahmed
- Division of Surgery and Interventional Science, University College London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals, UK
| | - Yipeng Hu
- Centre for Medical Imaging and Computing, University College London, UK
| | - Dean Barratt
- Centre for Medical Imaging and Computing, University College London, UK
| | | | | | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, UK
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Kuru TH, Roethke MC, Rieker P, Roth W, Fenchel M, Hohenfellner M, Schlemmer HP, Hadaschik BA. Histology core-specific evaluation of the European Society of Urogenital Radiology (ESUR) standardised scoring system of multiparametric magnetic resonance imaging (mpMRI) of the prostate. BJU Int 2013; 112:1080-7. [PMID: 23937255 DOI: 10.1111/bju.12259] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the Prostate Imaging Reporting and Data System (PIRADS) in multiparametric magnetic resonance imaging (mpMRI) based on single cores and single-core histology. To calculate positive (PPV) and negative predictive values (NPV) of different modalities of mpMRI. PATIENTS AND METHODS We performed MRI-targeted transrectal ultrasound-guided perineal prostate biopsies on 50 patients (mean age 66 years, mean PSA level of 9.9 ng/mL) with suspicion of prostate cancer. The biopsy trajectories of every core taken were documented in three dimensions (3D) in a 3D-prostate model. Every core was evaluated separately for prostate cancer and the performed biopsy trajectories were projected on mpMRI images. PIRADS scores of 1177 cores were then assessed by a histology 'blinded' uro-radiologist in T2-weighted (T2W), dynamic contrast-enhanced (DCE), diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS). RESULTS The PIRADS score was significantly higher in cores positive for cancer than in negative cores. There was a significant correlation between the PIRADS score and histopathology for every modality. Receiver operating characteristic (ROC) analysis showed excellent specificity for T2W (90% peripheral zone/97% transition zone) and DWI (98%/97%) images regardless of the prostate region observed. These numbers decreased for DCE (80%/93%) and MRS (76%/83%). All modalities had NPVs of 99%, if a PIRADS score threshold of 2 (for T2W, DCE, and MRS) or 3 (for DWI) was used. However, PPVs were low. CONCLUSIONS Our results show that PIRADS scoring is feasible for clinical routine and allows standardised reporting. PIRADS can be used as a decision-support system for targeting of suspicious lesions. mpMRI has a high NPV for prostate cancer and, thus, might be a valuable tool in the initial diagnostic evaluation.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Berg KD, Røder MA, Brasso K, Vainer B, Iversen P. Primary Gleason pattern in biopsy Gleason score 7 is predictive of adverse histopathological features and biochemical failure following radical prostatectomy. Scand J Urol 2013; 48:168-76. [PMID: 23889119 DOI: 10.3109/21681805.2013.821628] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to analyse whether primary Gleason pattern in biopsy Gleason score (GS) 7 predicted adverse histopathological features and had an impact on the risk of biochemical failure in a consecutive series of patients undergoing radical prostatectomy (RP). MATERIAL AND METHODS Between 2006 and 2010, 441 patients with biopsy GS 7 underwent RP at Rigshospitalet, Copenhagen, Denmark. Favourable histopathological features were defined as pT2 margin-negative cancer, RP specimen GS ≤ 3+4 and no lymph-node metastasis. Adverse histopathological features were defined as advanced pT3/4 cancer or pT2 margin-positive cancer and/or RP specimen GS ≥ 4+3 and/or positive lymph nodes. Biochemical failure was defined as the first prostate-specific antigen (PSA) ≥ 0.2 ng/ml. RESULTS A total of 344 patients (78.0%) had GS 3+4 in biopsies, while 97 patients (22.0%) had GS 4+3. No difference in age, PSA, percentage of biopsies with cancer, clinical tumour stage or volume on transrectal ultrasonography was found. Primary Gleason pattern 4 was associated with worse pathological stage (p = 0.049). On multivariate analysis, primary Gleason pattern 4 (p < 0.0001), cT stage (p = 0.024), PSA (p < 0.0001) and age (p = 0.009) predicted adverse histopathological features. In univariate analysis, Gleason score 3+4 had a significantly lower biochemical failure rate compared with Gleason score 4+3 (p = 0.0035). PSA (p < 0.0001), primary Gleason pattern 4 (p = 0.001) and percentage of biopsies with cancer (p = 0.02) were independently associated with risk of biochemical failure. CONCLUSIONS In biopsies with GS 7, a primary Gleason pattern 4 was associated with significantly elevated risk of adverse histopathological features and biochemical failure compared to pattern 3 in patients undergoing RP. This study underlines the heterogeneity of biopsy GS 7.
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